Disparities in routine healthcare utilization disruptions during COVID-19 pandemic among veterans with type 2 diabetes
© 2023. The Author(s)..
BACKGROUND: While emerging studies suggest that the COVID-19 pandemic caused disruptions in routine healthcare utilization, the full impact of the pandemic on healthcare utilization among diverse group of patients with type 2 diabetes is unclear. The purpose of this study is to examine trends in healthcare utilization, including in-person and telehealth visits, among U.S. veterans with type 2 diabetes before, during and after the onset of the COVID-19 pandemic, by demographics, pre-pandemic glycemic control, and geographic region.
METHODS: We longitudinally examined healthcare utilization in a large national cohort of veterans with new diabetes diagnoses between January 1, 2008 and December 31, 2018. The analytic sample was 733,006 veterans with recently-diagnosed diabetes, at least 1 encounter with veterans administration between March 2018-2020, and followed through March 2021. Monthly rates of glycohemoglobin (HbA1c) measurements, in-person and telehealth outpatient visits, and prescription fills for diabetes and hypertension medications were compared before and after March 2020 using interrupted time-series design. Log-linear regression model was used for statistical analysis. Secular trends were modeled with penalized cubic splines.
RESULTS: In the initial 3 months after the pandemic onset, we observed large reductions in monthly rates of HbA1c measurements, from 130 (95%CI,110-140) to 50 (95%CI,30-80) per 1000 veterans, and in-person outpatient visits, from 1830 (95%CI,1640-2040) to 810 (95%CI,710-930) per 1000 veterans. However, monthly rates of telehealth visits doubled between March 2020-2021 from 330 (95%CI,310-350) to 770 (95%CI,720-820) per 1000 veterans. This pattern of increases in telehealth utilization varied by community type, with lowest increase in rural areas, and by race/ethnicity, with highest increase among non-hispanic Black veterans. Combined in-person and telehealth outpatient visits rebounded to pre-pandemic levels after 3 months. Despite notable changes in HbA1c measurements and visits during that initial window, we observed no changes in prescription fills rates.
CONCLUSIONS: Healthcare utilization among veterans with diabetes was substantially disrupted at the onset of the pandemic, but rebounded after 3 months. There was disparity in uptake of telehealth visits by geography and race/ethnicity.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:23 |
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| Enthalten in: |
BMC health services research - 23(2023), 1 vom: 16. Jan., Seite 41 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Adhikari, Samrachana [VerfasserIn] |
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| Links: |
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| Themen: |
Covid-19 pandemic |
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| Anmerkungen: |
Date Completed 19.01.2023 Date Revised 11.02.2023 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1186/s12913-023-09057-8 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM351579923 |
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| 520 | |a © 2023. The Author(s). | ||
| 520 | |a BACKGROUND: While emerging studies suggest that the COVID-19 pandemic caused disruptions in routine healthcare utilization, the full impact of the pandemic on healthcare utilization among diverse group of patients with type 2 diabetes is unclear. The purpose of this study is to examine trends in healthcare utilization, including in-person and telehealth visits, among U.S. veterans with type 2 diabetes before, during and after the onset of the COVID-19 pandemic, by demographics, pre-pandemic glycemic control, and geographic region | ||
| 520 | |a METHODS: We longitudinally examined healthcare utilization in a large national cohort of veterans with new diabetes diagnoses between January 1, 2008 and December 31, 2018. The analytic sample was 733,006 veterans with recently-diagnosed diabetes, at least 1 encounter with veterans administration between March 2018-2020, and followed through March 2021. Monthly rates of glycohemoglobin (HbA1c) measurements, in-person and telehealth outpatient visits, and prescription fills for diabetes and hypertension medications were compared before and after March 2020 using interrupted time-series design. Log-linear regression model was used for statistical analysis. Secular trends were modeled with penalized cubic splines | ||
| 520 | |a RESULTS: In the initial 3 months after the pandemic onset, we observed large reductions in monthly rates of HbA1c measurements, from 130 (95%CI,110-140) to 50 (95%CI,30-80) per 1000 veterans, and in-person outpatient visits, from 1830 (95%CI,1640-2040) to 810 (95%CI,710-930) per 1000 veterans. However, monthly rates of telehealth visits doubled between March 2020-2021 from 330 (95%CI,310-350) to 770 (95%CI,720-820) per 1000 veterans. This pattern of increases in telehealth utilization varied by community type, with lowest increase in rural areas, and by race/ethnicity, with highest increase among non-hispanic Black veterans. Combined in-person and telehealth outpatient visits rebounded to pre-pandemic levels after 3 months. Despite notable changes in HbA1c measurements and visits during that initial window, we observed no changes in prescription fills rates | ||
| 520 | |a CONCLUSIONS: Healthcare utilization among veterans with diabetes was substantially disrupted at the onset of the pandemic, but rebounded after 3 months. There was disparity in uptake of telehealth visits by geography and race/ethnicity | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Covid-19 pandemic | |
| 650 | 4 | |a Health disparity | |
| 650 | 4 | |a Telehealth visits | |
| 650 | 4 | |a Type 2 diabetes care | |
| 650 | 4 | |a Veterans | |
| 650 | 7 | |a Glycated Hemoglobin |2 NLM | |
| 700 | 1 | |a Titus, Andrea R |e verfasserin |4 aut | |
| 700 | 1 | |a Baum, Aaron |e verfasserin |4 aut | |
| 700 | 1 | |a Lopez, Priscilla |e verfasserin |4 aut | |
| 700 | 1 | |a Kanchi, Rania |e verfasserin |4 aut | |
| 700 | 1 | |a Orstad, Stephanie L |e verfasserin |4 aut | |
| 700 | 1 | |a Elbel, Brian |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, David C |e verfasserin |4 aut | |
| 700 | 1 | |a Thorpe, Lorna E |e verfasserin |4 aut | |
| 700 | 1 | |a Schwartz, Mark D |e verfasserin |4 aut | |
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